脐动脉血血气分析在新生儿窒息诊断中的应用分析

Analysis on the application of umbilical cord blood gas analysis in diagnosis of neonatal asphyxia

目的探讨脐动脉血血气分析在新生儿窒息诊断和预后评估中的意义和价值。方法 415例合格病例纳入研究,统计与窒息相关的4个项目:1 min、5 min、10 min Apgar评分;脐动脉血p H值和碱剩余(BE)值;高危因素;器官损伤情况,研究各指标在窒息诊断中的灵敏度、特异度;研究窒息组和非窒息组脐动脉血p H值、BE值的分布特点;不同选点的脐动脉血p H、BE阈值的特异度及灵敏度。结果脐动脉血p H值、BE值、高危因素、Apgar评分、器官损伤各单项间均呈明显相关(P<0. 05),各项间可以互相补充,但不能互相取代。脐动脉血p H、BE与脏器损伤呈负相关(P<0. 05);窒息患儿的脐动脉血p H校正值分布范围为<7. 00~<7. 25,脐动脉血BE值分布范围为<-10~<-20 mmol/L。低Apgar评分结合脐动脉血p H<7. 15的灵敏度为52. 1%,特异度为65. 3%;结合脐动脉血p H<7. 10的灵敏度为41. 7%,特异度为73. 02%;结合脐动脉血p H<7. 00的灵敏度为31. 2%,特异度为82. 6%。结论脐动脉血血气分析有助于提高新生儿窒息诊断的准确率;脐动脉血p H值、高危因素、Apgar评分、器官损伤各项指标的综合诊断标准可以提高窒息的诊断准确性,减少误诊。

Objective To explore the significance and value of umbilical arterial blood gas analysis in the diagnosis and prognosis of neonatal asphyxia.Methods 415 eligible cases were included in the study,and four items related to asphyxia were counted:1 minute,5 minutes,10 minutes Apgar score;umbilical arterial blood p H and alkali residual(BE)values;high risk factors;organ damage,study the sensitivity,specificity and complementarity of individual items in the diagnosis of asphyxia;the distribution of p H value and BE value of umbilical arterial blood and the threshold value of BE value of different umbilical arteries in the asphyxiated group and non-asphyxia group the sensitivity and specificity of the point.Results Umbilical arterial blood p H,BE value,high risk factors,Apgar score,and organ damage were all significantly correlated(P<0.05),each could complement each other,but could not replace each other.Umbilical arterial blood p H,BE and Organ damage was negatively correlated(P<0.05);the umbilical arterial blood p H correction range of children with asphyxia was<7.00~<7.25,and the umbilical arterial blood BE value range was<-10~<-20 mmol/L.Low the sensitivity of the Apgar score combined with umbilical arterial blood p H<7.15 was 52.1%,the specificity was 65.3%;the sensitivity of umbilical arterial blood p H<7.10 was 41.7%,the specificity was 73.02%;the combination of umbilical arterial blood p H<7.00 The sensitivity was 31.2%and the specificity was 82.6%.Conclusion Umbilical arterial blood gas analysis can improve the accuracy of neonatal asphyxia diagnosis;the comprehensive diagnostic criteria of umbilical arterial blood p H,high risk factors,Apgar score,and organ injury indicators can improve the diagnostic accuracy of asphyxia and reduce misdiagnosis.